H1N1 - Guidelines

H1N1 Guidelines for:

Clinicians

Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who
> live in areas where human cases of swine influenza A (H1N1) have been identified or
> have traveled to an area where human cases of swine influenza A (H1N1) has been identified or
> have been in contact with ill persons from these areas in the 7 days prior to their illness onset.

If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer)
> Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory

Laboratory Workers

Diagnostic work on clinical samples from patients who are suspected cases of swine influenza A (H1N1) virus infection should be conducted in a BSL-2 laboratory
> All sample manipulations should be done inside a biosafety cabinet (BSC)

Viral isolation on clinical specimens from patients who are suspected cases of swine influenza A (H1N1) virus infection should be performed in a BSL-2 laboratory with BSL-3 practices (enhanced BSL-2 conditions)

Additional precautions include:
> recommended personal protective equipment (based on site specific risk assessment)
> respiratory protection - fit-tested N95 respirator or higher level of protection
> shoe covers
> closed-front gown
> double gloves
> eye protection (goggles or face shields)

Waste
> all waste disposal procedures should be followed as outlined in your facility standard laboratory operating procedures

Appropriate disinfectants
- 70 per cent ethanol
- 5 per cent Lysol
- 10 per cent bleach

All personnel should self monitor for fever and any symptoms. Symptoms of swine influenza infection include diarrhea, headache, runny nose, and muscle aches

Any illness should be reported to your supervisor immediately

For personnel who had unprotected exposure or a known breach in personal protective equipment to clinical material or live virus from a confirmed case of swine influenza A (H1N1), antiviral chemoprophylaxis with zanamivir or oseltamivir for 7 days after exposure can be considered

General Population

Covering nose and mouth with a tissue when coughing or sneezing (Dispose the tissue in the trash after use)
Handwashing with soap and water (Especially after coughing or sneezing)
Cleaning hands with alcohol-based hand cleaners
Avoiding close contact with sick people
Avoiding touching eyes, nose or mouth with unwashed hands
If sick with influenza, staying home from work or school and limit contact with others to keep from infecting them

Treatment

No vaccine available
Antivirals for the treatment and/or prevention of infection [Oseltamivir (Tamiflu) or Zanamivir (Relenza)]
Use of anti-virals can make illness milder and recovery faster
They may also prevent serious flu complications
For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms)
Warning! Do NOT give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome!

Quaratine/Isolation/Social-Distancing

Isolation: Refers only to the sequestration of symptomatic patents either in the home or hospital so that they will not infect others
Quarantine: Defined as the separation from circulation in the community of asymptomatic persons that may have been exposed to infection
Social-Distancing: Has been used to refer to a range of non-quarantine measures that might serve to reduce contact between persons, such as, closing of schools or prohibiting large gatherings

(27 April 2009 - tho)